Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $218.78 / $645.65	Facility		$69.18	$218.78	$645.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $12.88 / $40.74	Facility	26	$7.94	$12.88	$40.74
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.30 / $131.83 / $562.34	Facility	TC	$26.30	$131.83	$562.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $44.67 / $151.36	Professional		$9.12	$44.67	$151.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $15.85 / $45.71	Professional	26	$7.94	$15.85	$45.71
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $27.54 / $102.33 / $295.12	Professional	50	$27.54	$102.33	$295.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $43.65 / $95.50	Professional	TC	$24.55	$43.65	$95.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $36.31 / $69.18	Professional		$26.30	$36.31	$69.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.96 / $16.22	Professional	26	$7.08	$10.96	$16.22
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $41.69 / $64.57 / $104.71	Professional	50	$41.69	$64.57	$104.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.20 / $53.70	Professional	TC	$20.89	$30.20	$53.70
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $60.26 / $102.33	Facility		$35.48	$60.26	$102.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $44.67 / $77.62	Professional		$32.36	$44.67	$77.62
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.02 / $20.89	Professional	26	$8.91	$12.02	$20.89
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $48.98 / $67.61 / $117.49	Professional	50	$48.98	$67.61	$117.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.11 / $57.54	Professional	TC	$23.44	$33.11	$57.54
CareSource Facility/Professional Facility Modifier Low / Median / High Price $12.30 / $41.69 / $63.10	Facility		$12.30	$41.69	$63.10
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $33.88 / $48.98	Professional		$9.33	$33.88	$48.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $70.79 / $158.49	Facility		$47.86	$70.79	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $51.29 / $93.33	Professional		$31.62	$51.29	$93.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $13.49 / $23.44	Professional	26	$8.13	$13.49	$23.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $38.90 / $75.86	Professional	TC	$23.44	$38.90	$75.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $56.23 / $128.82	Professional		$42.66	$56.23	$128.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $12.59 / $32.36	Professional	26	$9.55	$12.59	$32.36
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $36.31 / $36.31 / $51.29	Professional	52	$36.31	$36.31	$51.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $43.65 / $95.50	Professional	TC	$33.88	$43.65	$95.50
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $39.81 / $70.79	Professional		$9.77	$39.81	$70.79
United Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $218.78 / $218.78	Facility		$26.30	$218.78	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $43.65 / $79.43	Professional		$32.36	$43.65	$79.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.72 / $19.95	Professional	26	$8.32	$10.72	$19.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $32.36 / $60.26	Professional	TC	$23.99	$32.36	$60.26